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I’m in a No-Fault State. What Does This Mean if I Have an Accident?

The term no-fault insurance confuses many people. It doesn’t mean that there is never any liability for a car accident. It doesn’t mean that you can’t contact a lawyer and receive compensation for your injuries. What does it mean? Here is an explanation.

What Is No-Fault Insurance?

No-fault insurance, also known as a personal injury protection (PIP) policy, is required in many states, including Florida. It is designed as a way to provide compensation quickly for accident victims through their own insurance, regardless of fault in the accident, and to reduce the number of personal injury lawsuits filed by car accident victims. PIP policies generally cover a portion of the costs of the following damages:

  • Medical costs: In Florida, PIP policies will cover up to 80 percent of medical costs for emergency medical conditions up to the limit of the policy, provided the treatment is received by a licensed physician, dentist, hospital, or facility that is owned by the hospital. For less serious injuries, the policy will provide up to $2,500.
  • Lost wages: PIP policies cover a portion of the wages that an injured accident victim lost due to being too injured to work or work missed for doctor’s appointments or medical procedures related to the injury. In Florida, PIP policies are required to cover up to 60 percent of lost wages, based on the individual’s income for 13 weeks immediately preceding the accident.
  • Death benefits, including funeral and burial expenses. Florida’s PIP policies provide up to $5,000 in death benefits to qualified survivors.

While these items are usually covered through an individual’s PIP policy, a number of common damages from car accidents are not. Those items not covered by no-fault insurance policies include:

  • Damage to your car and other property or the other driver’s car or property
  • The bodily injuries of the other car’s occupants
  • The bodily injuries of adult passengers in your vehicle or adult friends who have borrowed your car, provided they have their own PIP coverage and are not named on your policy.
  • Pain and suffering claims

When you submit a PIP claim, your insurer has 30 days to either accept the claim and pay the expenses or deny the claim. If your claim is denied, the insurer must provide you with a written explanation as to why it was denied. You will be provided with an opportunity to appeal the denial, and a qualified car accident attorney can assist you with that appeal.

Certain vehicles are excluded from the requirement of no-fault coverage, including motorcycles, specialty vehicles designed for off-road use, and commercial or business vehicles. However, if you’re injured in an accident while riding your motorcycle, or even as a pedestrian or a bicyclist, the PIP policy that you purchased for your car may cover your injuries.

Which States Require No-Fault Insurance?

In addition to Florida, the following jurisdictions have no-fault insurance systems:

  • District of Columbia
  • Hawaii
  • Kansas
  • Kentucky
  • Massachusetts
  • Michigan
  • Minnesota
  • New Jersey
  • New York
  • North Dakota
  • Puerto Rico
  • Utah

The rules regarding no-fault insurance and making a claim vary among the above locations. In fact, some states allow residents to opt out of the no-fault system when they purchase their car insurance policy. Florida’s insurance laws, however, mandate that you carry a no-fault insurance policy with a minimum limit of $10,000 upon registering your vehicle. You are also required to purchase property damage liability insurance that will cover the costs of damage to the other driver’s vehicle if you cause an accident.

What’s Good and Bad About No-Fault Insurance?

Proponents of no-fault insurance like that it allows drivers to deal with their own insurance company when they are injured in an accident, rather than the traditional method of determining blame and forcing accident victims to prove their injuries to another driver’s insurance company, which often results in a lawsuit being filed. With PIP, no blame has to be assessed before coverage begins, meaning that medical expenses and lost wages can be paid out under the policy in a more timely fashion.

However, there are some negatives to no-fault insurance, as well. One of the cons of this type of insurance is that the claim on the driver’s insurance—even if they were not at fault for the accident—may result in an increase in premiums. In 2013, new laws were put forth that govern how much a person can be compensated for their PIP claim, resulting in a lower payout for those whose medical conditions are not deemed to be emergent. Additionally, unless a person’s injuries are found to be permanent, they are not eligible to file a personal injury lawsuit against the at-fault driver and cannot access funds for general damages such as pain and suffering.

In no-fault states, auto insurance companies pay for a larger number of medical services and they pay more for medical services than they do in states without a no-fault system. This may result in higher insurance premiums for drivers in no-fault states as a whole. No-fault states tend to see a higher number of fraudulent claims, as well. The reforms to Florida’s no-fault insurance law that were passed in 2012 and implemented in 2013 reportedly caused a significant reduction in the number of fraudulent PIP claims that the state receives.

What Happens If I Cause an Accident?

If you cause an accident and you are injured, you are generally allowed to file a claim under your PIP policy with your insurance company. The exception to this would be if you are found to have been driving while impaired at the time of the accident or you intentionally caused the accident. In Florida, you must seek medical treatment within fourteen days in order to be eligible for compensation through your PIP policy.

If the other driver or the occupants of the other car are also injured, their own PIP policy will cover their injuries, up to the limits of the policy. However, if their expenses exceed the limits of their policy, they may make a third-party claim against your insurance. If their injuries are determined to be serious or permanent, they may file a personal injury lawsuit against you.

In addition to a no-fault insurance system, Florida also has a system of pure comparative negligence that applies to personal injury lawsuits. What this means is that even if the other driver had some blame for the accident, they can still seek compensation from you in the event of serious and permanent injuries. However, any award they receive will be reduced by the percentage of blame that is theirs.

What Happens if I Am Injured in an Accident Caused by Someone Else?

If you are injured in an accident caused by the negligence of another person, you should seek medical care immediately. Not only is this just good sense, but also Florida’s no-fault law requires that you seek initial medical treatment within the 14 days of your accident in order to receive PIP benefits. Not seeking treatment could not only deprive you of PIP benefits, but could also make it harder for you to recover benefits from any insurance you may carry.

You will want to file a claim under your PIP policy, even if your injuries are serious or permanent. This will give you access to compensation for your initial treatment. You will likely find that the $10,000 policy limit will be spent pretty quickly on your initial emergency room visit. You will want to speak to an attorney about the potential of filing a third-party claim if the driver had bodily injury liability coverage, filing a personal injury lawsuit against the other driver, or any other legal options you might have according to the facts of your case.

Are There Reasons Why My PIP Claim Would Be Denied or Reduced?

You pay the premiums for your insurance policy and now you’re injured and have made a claim under your PIP policy. Is there any reason to worry that your claim will be denied? Unfortunately, yes. PIP claims are denied or reduced for a number of reasons, including:

  • The medical treatment that you received was not reasonable or necessary, or it was not provided by a licensed physician, dentist, hospital, or a facility owned by the hospital.
  • The deadline has passed for you to make a claim, or you did not seek medical treatment within the 14 day window for PIP coverage eligibility.
  • Your injuries were not found to be an emergency medical condition and therefore don’t qualify for compensation up to your policy limit.
  • The injuries were found to be due to a pre-existing condition or were not a product of the accident.
  • You intentionally caused the accident, the accident occurred while you were committing a felony, or you were driving someone else’s car without their permission when the accident took place.
  • Your insurance has lapsed or the damages you are asking for are not covered in your policy.

Can I Still File a Personal Injury Lawsuit Against a Negligent Driver?

Florida allows accident victims who suffer serious and permanent injuries, and whose damages exceed the limits of their PIP coverage, to seek compensation through a personal injury lawsuit. Permanent injuries, as defined by law, include:

  • Significant and permanent loss of an important bodily function
  • Permanent injury within a reasonable degree of medical probability
  • Significant scarring or disfigurement
  • Wrongful death

If you are found to have sustained an injury that meets the state law’s permanent injury threshold, then you may be eligible to seek the recovery of damages for:

  • Medical expenses beyond your PIP policy’s limits, and future medical care
  • Lost wages and loss of future earning capacity
  • The cost of household services that you are no longer able to do as a result of your injuries
  • Property that was damaged in the accident
  • Permanent disfigurement or disability
  • Pain and suffering
  • Loss of consortium
  • Emotional distress

If you pursue compensation via a personal injury lawsuit, your attorney will look to see if any of the following situations apply:

  • Was there more than one liable party? In Florida, if a person, business, or entity can be subject to liability if at least 10 percent responsible for causing the accident that led to your serious or permanent injury. An example of a case where there is more than one liable party is if your accident was caused by a negligent driver who is driving a company truck, is on the clock, and whose previous driving experience should have been examined more thoroughly before he or she was hired. In this case, both the driver and the company that the driver works for may be found liable for your injuries.
  • Will your lawsuit be filed in time to meet the state’s statute of limitations? In Florida, the time limit for filing a personal injury lawsuit is four years from the date of the injury.
  • What were your damages and how much should you ask for? Your attorney will help you determine an amount of compensation to ask for based on the costs of your economic damages, such as medical bills and lost wages as well as your general damages, which include impacts to your quality of life such as pain and suffering or emotional distress. Your attorney will also evaluate the facts of your case to determine if there is reason to add punitive damages to your claim. Punitive damages are designed to punish defendants whose behavior was particularly reckless or negligent.

Do I Need an Attorney to File a Claim on My No-Fault Insurance?

You do not need an attorney to file a claim with your no-fault insurance carrier. However, it is always helpful to have an attorney to provide guidance and answer any questions you may have during the insurance claim process. Additionally, if you are denied coverage by your PIP provider or your costs exceed the limits of your policy, then you may want to examine your case with an attorney to determine your best legal course of action.

Let us help put you on the path to obtaining compensation for your injuries. With offices across both Florida coasts, you can easily reach Dolman Law Group Accident Injury Lawyers, PA, and Sibley Dolman Accident Injury Lawyers, LLP, at 833-552-7274 (833-55-CRASH), or contact us online.

Dolman Law Group Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33765
(727) 451-6900

Florida Personal Injury Attorneys